Train Smarter, Not Harder - Improving Back Pain with Exercise

By Mike Casey BSc (Hons), CHEK Exercise Coach, CMTA I
April 07

We have all heard the statistics before! Back pain will affect 95% of us at some point in our lives! 4.5 million working days are lost each year due to musculo-skeletal disorders mainly affecting the back and the charity Back Care estimates that back pain costs the NHS, business and the economy over £5 billion per year!

What is going on here? We have more osteopaths, chiropractors, physiotherapists, massage therapists, personal trainers and acupuncturists than ever before, yet the statistics are getting worse. Its no secret that if someone gets out of bed, sits in their car and drives to work, sits at their desk for 10 hours, sits back in the car, drives home and then sits in front of the television for the remainder of the evening before going to bed, THEY ARE GOING TO GET BACK PAIN! The human body is not designed to sit and if it is asked to do just that for 40 years of its life, problems will result.

Even when sitting with good posture there is 40% more loading on the spine due to altered posture and weight-bearing than when standing with good posture. Poor posture when sitting can result in anything between 85% and 175% more loading.

Where as 30 years ago, the common treatment for back pain was rest, many experts now recognise that getting the body to do the very thing that likely gave it back pain in the first place is counter-productive and that exercise and movement are very important components of a treatment programme for back pain. 

And now to the point of the article - how do you know if your exercise programme is making your back worse and if you don’t have back pain, is your programme likely to prevent it or cause it?

I will look at posture, core conditioning and lifestyle, evaluating how these relate to exercise and back pain.

Firstly, let’s start with posture. Just as a car that has poor tracking will cause the tyres to wear unevenly, poor posture will alter the load-bearing on the tissues and vertebra of the spine, causing tissue damage. Over time this can lead to either injuries to the facet joints or the discs and in more extreme cases can cause a disc bulge. It is therefore very important that you have a full postural assessment before you begin an exercise programme to ensure you are not exacerbating any existing postural problems. Let me give you an example. Let’s call the individual I described above, who spends their whole day sitting, John. It is very likely that, due to his lifestyle, John has what is commonly referred to as a flat back. This is where the optimum curvature of the lower part of the spine has reduced and therefore is too straight, placing undue stress on the discs (a tingling in the left leg may also be noticed due to compression of the spinal cord). Now, if John heads off to the gym and starts doing abdominal crunches or stretching his lower back you might think this will help - after all he is strengthening his abs to promote stability and stretching his back to improve flexibility. Unfortunately, in this example, these two exercises could not be worse for John and will only serve to flatten his back even further. To begin to re-align his spine, what John actually needs to do is strengthen his lower back (stretching it will only make it weaker) and stretch his abdominal muscles (which are too strong and pulling the spine out of line). In this very simple example, you begin to see the requirement of a full postural assessment as there are many other examples of how the spine can be affected by the wrong types of exercise. Make sure you quiz your trainer about the assessments they will conduct and how the exercise programme they are giving you will affect your posture.

Secondly, let’s look at core conditioning. If you have back pain that gets worse the longer you stand up, it is very likely you have weak core musculature. In simple terms, the core muscles are those that surround the lower part of your back - the deep abdominals (not your six-pack!) and low back muscles. If these muscles are weak or have poor coordination, instability results, leading to back pain. The concept of core stability is quite a ‘buzz’ in the fitness industry at the moment however, as with posture, it is critical to seek an assessment before commencing a core conditioning programme. It has been shown that 95% of individuals with low back pain cannot effectively recruit their deep abdominals. If this is the case then any form of functional exercise (such as running, squatting, using a Swiss ball) that places a load on the spine could be dangerous because the spine is ‘naked’ - the deep abdominal muscles have not contracted to provide stiffness and stability to the spine. There are also different levels of core function, which is where the assessment becomes so vital. If you are exercising at the wrong level, then it will either be dangerous or just a waste of time. For example an individual may have good coordination in their deep abdominals in which case you could graduate on to some strength work. However, if there is no coordination then strength work (such as the plank - a very commonly prescribed exercise for the core) will be dangerous. It is very important to note that even if you do not have back pain, you should seek a core assessment before commencing an exercise programme as you could put yourself at risk of future pain. An interesting point is that I have NEVER assessed a client who had effective coordination and 100% strength in their deep abdominals, regardless of whether they had back pain or not! The cause of these widespread results can be attributed to the same as that of poor posture - sitting! When the body is not used enough and too much support is provided (one of the problems with machine weights!), the core muscles are not needed and will ‘go to sleep’. If this happens over the course of 20 years, these muscles will become virtually dormant.

I would like to finish the article by talking briefly about lifestyle. To see truly effective results from your exercise programme with regard to back pain, it is important to pay attention to your lifestyle habits. Again, it is important to seek guidance on these topics to ensure that you are not wasting time or making matters worse. Proper nutrition is imperative to deal with your back pain, ensuring that you are eating according to your metabolic type (visit www.healthexcel.com for a list of advisors or speak to one of the trainers at Take Shape) and also that you are not eating anything you are intolerant to should be near to the top of your list with regards to nutrition. Let me give you a brief example to try and highlight the importance of this. Pain impulses that come from the small intestine, bowel or any organ of digestion due to eating either something one is intolerant to or is overly processed will cause inhibition (weakness) in the abdominal wall. This is due to the inflammation which occurs when eating such foods. Therefore, regardless of how much core conditioning is performed, if the organs beneath the abdominal wall are inflamed, these muscles will not respond to exercise. Other factors that need to be considered are sleep patterns and breathing patterns as these both affect your digestion and also recovery from exercise.

I believe exercise to be a necessary component of any rehabilitation from exercise, providing it is managed correctly. It is very important to remember that you must seek the advice of a good osteopath, chiropractor or your local GP before commencing a programme.

Reference:

Chek, P. (1999) How to Eat, Move and Be Healthy. C.H.E.K. Institute: San Diego, CA.

Kendall, F.P., McCreary, E.K., Provance, P.G., Rodgers, M.M. and Romani, W.A. (2005) Muscles: Testing and Function with Posture and Pain. Lippincott Williams & Wilkins. Baltimore, MD.

Richardson, C., Jull, G., Hides, J. and Hodges, P. (1998) Therapeutic Exercise for Spinal Segmental Stabilisation in Low Back Pain. Churchill Livingstone.